By Bonnie Miller Rubin, Chicago Tribune reporter
July 18, 2012
Health care has dominated the headlines recently at the federal, state and local levels:
The Supreme Court upholds the Affordable Care Act. Six of 12 Chicago-run community mental health clinics are shut, as is the state-run Tinley Park Mental Health Center.
To help sort out what impact these developments will have on the emotional/behavioral health front, we turned to Mark Heyrman, a professor of law at the University of Chicago Law School and past president of Mental Health America of Illinois:
Q: What does the Affordable Care Act mean for Americans with psychiatric disorders?
A: It may be the most important piece of legislation affecting people with mental illness in decades because it provides insurance for millions who are uninsured due to prior existing conditions. With mental illness, the usual age of onset is teens or early 20s, which means it's impossible to get coverage once you have symptoms. ... The Affordable Care Act will prohibit insurance companies from denying coverage due to pre-existing conditions.
Also, the expansion of Medicaid will be a big boon because Medicaid is the largest funder of mental health services in Illinois and every other state.
Q: You are suing the state — along with the National Alliance on Mental Illness of Illinois and Mental Health America of Illinois — to make sure the money from closing Tinley Park gets redirected to other mental health services. What kind of services would you like to see?
A: What is lacking is an array of low-cost, simple services — medications, group therapy or periodic, individual therapy. ... For someone whose illness is in remission that is frequently all that's necessary to keep someone healthy. It could be put into supportive employment, so people can be gainfully employed and pay taxes. In Illinois, we simply have not done enough of that kind of thing.
Q: And what about those who are not doing so well?
A: For people who are quite sick, there are peer-supported services, where people who have a mental illness and are doing well are enlisted to help engage others in treatment before things get out of control. And then, there's assertive community treatment, which will check in on you, remind you to take your meds, help solve problems — such as a conflict with a landlord. ... It's still less expensive than a hospital admission or getting into the criminal justice system.
Q: Illinois has such a dismal track record when it comes to mental health, including getting a "D" in NAMI's most recent state report card rankings. Why are we at the bottom?
A: Partly because we have spent our money in foolish and expensive ways ... by putting people with mental illness in nursing homes. ... If you put people in IMDs (Institutes for Mental Diseases), the entire cost ($30,000) is borne by taxpayers. If you supply community services, the feds will match or share the cost at least 50 percent. ... We leave money in Washington that would provide better care and save Illinois taxpayers money. We rely on nursing homes more than any other state in the country because of powerful interest groups ... and we just can't seem to get this fixed.
Q: Why do mental health services seem to always fall to the budget ax?
A: There's a problem finding adequate support because of the stigma and failure of lawmakers to recognize its prevalence. People don't rush to be spokesmen for mental health.
Q: Do you think all the veterans returning from the Middle East with PTSD and other emotional disorders will change the landscape?
A: This is the first time a lot of attention is being paid to the mental health effects of war. ... We're recognizing that repeated deployments can be worse than one ongoing deployment ... and more veterans died by suicide than combat. It's positive that the Obama administration has vastly increased services across the country for veterans from Iraq and Afghanistan.
Q: So what advice would you give people who aren't veterans, but are struggling and losing state coverage?
A: With the Affordable Care Act, there'll be more money for mental health in 2014. It is the job of everyone to try to help you hang on until then.
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